Tag: long covid symptoms

Prevalence of peripheral neuropathy and myopathy in patients post-COVID-19 infection

Abstract:

Background: Severe acute respiratory syndrome (SARS-CoV-2), caused by the Coronavirus 2019 (COVID-19), has become a life-threatening epidemic, affecting multiple organs, including the nervous system. Recent studies have documented that COVID-19-associated peripheral neuropathy is a common and frequent problem, with central and peripheral nervous system complications.

Objective: This work aims to evaluate the peripheral nerves and muscle involvement after COVID-19 infection, in addition to studying the prevalence rate and risk factors of their affection.

Methods: The study involved 400 patients, divided into 2 groups, with a history of COVID-19 infection with or without symptoms of neuromuscular affection, and 30 gender- and age-matched healthy volunteers were involved as controls. They were referred to the Department of Rheumatology and Rehabilitation for electro-diagnosis. All participants performed complete clinical examination and laboratory measures with an electrophysiological study.

Results: The prevalence of peripheral neuropathy and myopathy in post-COVID-19 patients was 56.3% among all patients. A significant difference was detected among patients of both groups regarding serum creatine phosphokinase level, clinical signs, and electrophysiologic findings of neuropathy and myopathy compared to the control group, with more prominent features among the symptomatic group. Histories of hospitalization, severe and long-lasting respiratory symptoms were risk factors for developing neuromuscular complications.

Conclusions: The present study could indicate that muscle involvement and peripheral nerve affection are common problems even among asymptomatic patients after COVID-19 infection, especially in the presence of any risk factors.

Source: Saif DS, Ibrahem RA, Eltabl MA. Prevalence of peripheral neuropathy and myopathy in patients post-COVID-19 infection. Int J Rheum Dis. 2022 Aug 1. doi: 10.1111/1756-185X.14409. Epub ahead of print. PMID: 35915515. https://onlinelibrary.wiley.com/doi/10.1111/1756-185X.14409 (Full text)

Neurological manifestations of post-COVID-19 syndrome S1-guideline of the German society of neurology

Abstract:

Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to COVID-19 (COrona VIrus Disease-2019). SARS-CoV-2 acute infection may be associated with an increased incidence of neurological manifestations such as encephalopathy and encephalomyelitis, ischemic stroke and intracerebral hemorrhage, anosmia and neuromuscular diseases. Neurological manifestations are commonly reported during the post-acute phase and are also present in Long-COVID (LCS) and post-COVID-19 syndrome (PCS).

In October 2020, the German Society of Neurology (DGN, Deutsche Gesellschaft für Neurologie) published the first guideline on the neurological manifestations of COVID-19. In December 2021 this S1 guideline was revised and guidance for the care of patients with post-COVID-19 syndrome regarding neurological manifestations was added. This is an abbreviated version of the post-COVID-19 syndrome chapter of the guideline issued by the German Neurological society and published in the Guideline repository of the AWMF (Working Group of Scientific Medical Societies; Arbeitsgemeinschaft wissenschaftlicher Medizinischer Fachgesellschaften).

Source: Franke C, Berlit P, Prüss H. Neurological manifestations of post-COVID-19 syndrome S1-guideline of the German society of neurology. Neurol Res Pract. 2022 Jul 18;4(1):28. doi: 10.1186/s42466-022-00191-y. PMID: 35843984; PMCID: PMC9288923. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288923/ (Full text)

Postural balance and its association with functionality and quality of life in non-hospitalized patients with post-acute COVID-19 syndrome

Abstract:

Background and objectives: The neuromuscular system is responsible for performing adequate muscle activities to maintain postural balance. Since COVID-19 can cause damage to this system, long-term sequelae might alter control of postural stability. This study aimed to evaluate the postural balance of patients with post-acute COVID-19 syndrome (PCS) who were not hospitalized and to evaluate the correlations of changes in postural balance with general fatigue, muscle strength, and quality of life (QoL).

Methods: This was a cross-sectional study in which 40 patients with PCS and 40 controls underwent balance assessment through the Berg Balance Scale (BBS) and Tinetti Balance Scale (TBS). They were evaluated for general fatigue by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, handgrip strength (HGS), and quality of life (QoL) by the Short Form-36 (SF-36).

Results: When compared to controls, patients with PCS had lower BBS and TBS scores (p = 0.001 for both). The FACIT-F score was lower in PCS patients (p = 0.0001). HGS was slightly lower in the PCS patients, but not statistically significant (p = 0.09). Regarding QoL, PCS patients showed worse evaluations in five dimensions of the SF-36 (physical functioning, physical role limitations, bodily pain, general health perceptions, and mental health). Both the BBS and TBS scores had statistically significant positive correlations with the FACIT-F score, HGS, and two SF-36 dimensions (physical role limitations and emotional role limitations).

Conclusions: Patients with PCS show worse postural balance than controls, which is associated with general fatigue, lower HGS, and poor QoL. Postural balance assessment should be considered in the follow-up and rehabilitation of PCS.

Source: de Sousa KCA, Gardel DG, Lopes AJ. Postural balance and its association with functionality and quality of life in non-hospitalized patients with post-acute COVID-19 syndrome. Physiother Res Int. 2022 Jul 17:e1967. doi: 10.1002/pri.1967. Epub ahead of print. PMID: 35842844. https://onlinelibrary.wiley.com/doi/10.1002/pri.1967 (Full text)

Spectrum of neurological manifestations among acute COVID-19 and long COVID-19 – A retrospective observational study

Abstract:

Objective. Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological symptoms. To compare the clinical features, imaging and treatments in patients with and without COVID 19. To compare the mortality and in-hospital stay among patients with and without COVID 19 and negative patients.

Materials and methods:In this retrospective, single-center study, we included all the patients who attended the department of neurology with neurologic symptoms with confirmed COVID-19 and long COVID-19 from June 2020 to January 2021. Data on clinical signs, diagnosis, laboratory findings were collected and analyzed from the records for positive patients and compared with neurologic patients without COVID-19 admitted in the same period.

Statistical analysis: The mean values between study groups were compared using an independent sample t-test and Mann Whitney u test. Categorical outcomes were compared using the Chi square test. Data was analyzed using coGuide software.

Results: Headache was the common neurologic manifestation present in COVID positive patients compared to COVID negative patients (39.13%). There was no statistically significant difference between the two groups in baseline parameters. Laboratory parameters like CRP, Serum Ferritin, LDH, D-dimer, ESR, and IL-6 showed a significant increase in COVID positive patients (P <0.05). In-hospital mortality was more in COVID positive patients than COVID negative patients (P <0.011).

Conclusion:The study showed varied neurologic symptoms in COVID patients, with headache as the common symptom. Hospital stay, morbidity, mortality, and inflammatory parameters were more in COVID positive patients compared to COVID negative patients.

Source: Pooja Dugani, Anish Mehta, Sunil V Furtado, R. Pradeep, Mahendra Javali, Purushottam Acharya, Vijayashree Thyagaraj, R. Srinivasa. Spectrum of neurological manifestations among acute COVID-19 and long COVID-19 – A retrospective observational study. Ref: Ro J Neurol. 2022;21(2) DOI: 10.37897/RJN.2021.2.14.  https://rjn.com.ro/articles/2022.2/RJN_2022_2_Art-14.pdf (Full text)

Long-COVID in immunocompromised children

Abstract:

Coronavirus disease 2019 (COVID-19) can lead to an illness characterized by persistent symptoms which affect various organs and systems, known as long-COVID. This study aimed to assess the prevalence and clinical characteristics of long-COVID in children with immunodeficiency, in comparison to those without. A self-constructed questionnaire was created, which included questions regarding the child’s general health, the course of their COVID-19, their symptoms of long-COVID and its impact on their daily functioning, the diagnosis of multisystem inflammatory syndrome (MIS-C), and vaccination status. The questionnaire was completed by parents of 147 children – 70 children with a diagnosis of immunodeficiency (47.6%) and 77 who were immunocompetent (52.4%).

Immunocompetent children were more significantly affected by long-COVID than those immunocompromised. Its prevalence in the first 12-week post-infection was 60.0% and 35.7% in these groups, respectively. Beyond this period, these percentages had dropped to 34.6% and 11.43%, respectively. Children who were immunocompetent reported more often symptoms of fatigue, reduced exercise tolerance, and difficulty concentrating. Meanwhile, there was a slight increase in complaints of gastrointestinal symptoms in immunocompromised patients. The risk of developing long-COVID increased with age and COVID-19 severity in both groups. Furthermore, the daily activities of immunocompetent children were limited more frequently (41.8%) than for those who were immunocompromised (25%).

Conclusions: Although immunocompromised children experienced long-COVID, its prevalence and impact on daily functioning were significantly lower than among immunocompetent children. However, as the pathomechanisms of long-COVID are not yet fully understood, it is not currently possible to fully explain these findings.

What is known: • Long COVID is characterized by persistent symptoms following COVID-19, which can affect various tissues and organs, as well as mental health. • Due to the similar course of COVID-19 – mainly mild or asymptomatic – among children with and without immunodeficiency, the question arises, over whether the prevalence and severity of long-COVID is also similar in both groups.

What is new: • Immunocompromised children also suffer from long-COVID, but the prevalence is significantly lower than in the immunocompetent group of children. • The potential causes of less frequent and milder long-COVID in this group may be the milder course of COVID-19 and the state of reduced immunity protecting against neuroinflammation.

Source: Kuczborska K, Buda P, Książyk J. Long-COVID in immunocompromised children. Eur J Pediatr. 2022 Jul 14:1–9. doi: 10.1007/s00431-022-04561-1. Epub ahead of print. PMID: 35834042; PMCID: PMC9281224.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9281224/ (Full text)

Orbito-Frontal Cortex Hypometabolism in Children With Post-COVID Condition (Long COVID): A Preliminary Experience

Abstract:

We describe 3 children with new-onset neurocognitive problems after coronavirus disease 2019 (COVID-19), that showed, at the brain [18F]-fluorodeoxyglucose positron emission tomography/computed tomography, hypometabolism in the left orbito-frontal region. The voxel-wise analysis confirmed a cluster of hypometabolic voxels in this region with a peak at -18/46/-4mm (179 voxels, T-Score 8.1). These findings may explain neurocognitive symptoms that some children develop after COVID-19 and require further investigations.

Source: Cocciolillo F, Di Giuda D, Morello R, De Rose C, Valentini P, Buonsenso D. Orbito-Frontal Cortex Hypometabolism in Children With Post-COVID Condition (Long COVID): A Preliminary Experience. Pediatr Infect Dis J. 2022 Aug 1;41(8):663-665. doi: 10.1097/INF.0000000000003578. Epub 2022 Jul 13. PMID: 35839175.  https://pubmed.ncbi.nlm.nih.gov/35839175/

Post-acute Sequelae of SARS-CoV-2 Infection: A Neglected Public Health Issue

Introduction:

The COVID-19 pandemic has caused at least 508,827,830 infections and is associated with a 1.2% mortality rate worldwide (). New SARS-CoV-2 variants have driven new waves of the pandemic as a result of their increased transmissibility and ability to evade the immune response (). The post-acute sequelae of SARS-CoV-2 infection (PASC) is an important but underestimated public health issue that can have a long-term impact on pulmonary and multiple extrapulmonary tissues and organs through several potential mechanisms (, ). Recent studies demonstrate that approximately 4–69% of patients (including children, adolescents, adults, and senior) suffer from PASC (–). There is considerable evidence concerning post-acute sequelae that will likely outlast the current pandemic and need to be addressed. This article reviews the clinical sequelae of COVID-19 survivors and provides valuable insights required to fill the gaps in medical knowledge.

Source: Wang Z, Yang L. Post-acute Sequelae of SARS-CoV-2 Infection: A Neglected Public Health Issue. Front Public Health. 2022 Jun 17;10:908757. doi: 10.3389/fpubh.2022.908757. PMID: 35784200; PMCID: PMC9247346. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9247346/ (Full text)

Long COVID, audiovestibular symptoms and persistent chemosensory dysfunction: a systematic review of the current evidence

Abstract:

in English, Italian

Objective: The persistence of auditory, vestibular, olfactory, and gustatory dysfunction for an extended time after COVID-19 has been documented, which represents an emerging challenge of which ENT specialists must be aware. This systematic review aims to evaluate the prevalence of persistent audiovestibolar and olfactory/gustatory symptoms in patients with “long-COVID”.

Methods: The literature was systematically reviewed according to PRISMA guidelines; PubMed, Scopus and Google Scholar were screened by searching articles on audiovestibular symptoms and olfactory/gustatory dysfunction after SARS-CoV-2 infection. The keywords used were hearing loss, tinnitus, vertigo, smell disorders, parosmia, anosmia, hyposmia, dysgeusia combined with COVID-19 or SARS-CoV-2.

Results: 1100 articles were identified. After removal of duplicates (382), 702 articles were excluded, and 16 were included in the systematic review. All articles included identified an association between SARS-CoV-2 infection and persistent hearing or chemosensory impairment. The studies were published over a period of 2 years, between 2019 and 2021.

Conclusions: The likelihood of patients with persistent audiovestibular symptoms related to COVID-19 was different among the articles; however, olfactory and gustatory disturbances were more consistently reported. Studies with longer follow-up are required to fully evaluate the long-term impact of these conditions.

Source: De Luca P, Di Stadio A, Colacurcio V, Marra P, Scarpa A, Ricciardiello F, Cassandro C, Camaioni A, Cassandro E. Long COVID, audiovestibular symptoms and persistent chemosensory dysfunction: a systematic review of the current evidence. Acta Otorhinolaryngol Ital. 2022 Apr;42(Suppl. 1):S87-S93. doi: 10.14639/0392-100X-suppl.1-42-2022-10. PMID: 35763279; PMCID: PMC9137376. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9137376/ (Full text)

COVID fog demystified

Abstract:

Acute mild respiratory SARS-CoV-2 infection can lead to a more chronic cognitive syndrome known as “COVID fog.” New findings from Fernández-Castañeda et al. reveal how glial dysregulation and consequent neural circuit dysfunction may contribute to cognitive impairments in long COVID.

Source: Kao J, Frankland PW. COVID fog demystified. Cell. 2022 Jul 7;185(14):2391-2393. doi: 10.1016/j.cell.2022.06.020. Epub 2022 Jun 15. PMID: 35768007; PMCID: PMC9197953. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9197953/ (Full text)

Bridging Knowledge Gaps in the Diagnosis and Management of Neuropsychiatric Sequelae of COVID-19

Abstract:

Importance: Neuropsychiatric symptoms have been reported as a prominent feature of postacute sequelae of COVID-19 (PASC), with common symptoms that include cognitive impairment, sleep difficulties, depression, posttraumatic stress, and substance use disorders. A primary challenge of parsing PASC epidemiology and pathophysiology is the lack of a standard definition of the syndrome, and little is known regarding mechanisms of neuropsychiatric PASC.

Observations: Rates of symptom prevalence vary, but at least 1 PASC neuropsychiatric symptom has been reported in as many as 90% of patients 6 months after COVID-19 hospitalization and in approximately 25% of nonhospitalized adults with COVID-19. Mechanisms of neuropsychiatric sequelae of COVID-19 are still being elucidated. They may include static brain injury accrued during acute COVID-19, neurodegeneration triggered by secondary effects of acute COVID-19, autoimmune mechanisms with chronic inflammation, viral persistence in tissue reservoirs, or reactivation of other latent viruses. Despite rapidly emerging data, many gaps in knowledge persist related to the variable definitions of PASC, lack of standardized phenotyping or biomarkers, variability in virus genotypes, ascertainment biases, and limited accounting for social determinants of health and pandemic-related stressors.

Conclusions and relevance: Growing data support a high prevalence of PASC neuropsychiatric symptoms, but the current literature is heterogeneous with variable assessments of critical epidemiological factors. By enrolling large patient samples and conducting state-of-the-art assessments, the Researching COVID to Enhance Recovery (RECOVER), a multicenter research initiative funded by the National Institutes of Health, will help clarify PASC epidemiology, pathophysiology, and mechanisms of injury, as well as identify targets for therapeutic intervention.

Source: Frontera JA, Simon NM. Bridging Knowledge Gaps in the Diagnosis and Management of Neuropsychiatric Sequelae of COVID-19. JAMA Psychiatry. 2022 Jun 29. doi: 10.1001/jamapsychiatry.2022.1616. Epub ahead of print. PMID: 35767287.  https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2793903 (Full text)